Healthcare Provider Details

I. General information

NPI: 1457712523
Provider Name (Legal Business Name): AUDREY LAMBERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E 1ST ST
DUMAS TX
79029-3219
US

IV. Provider business mailing address

11623 ARBOR ST
OMAHA NE
68144-2981
US

V. Phone/Fax

Practice location:
  • Phone: 806-934-2634
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4435
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1239650
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: